Critical Matters

Latest Episodes:

Invasive Candidiasis May 14, 2026

Show notes

In this, Dr. Sergio Zanotti discusses the management of invasive candidiasis in critically ill patients. Invasive candidiasis is frequent in critically ill patients and is associated with high mortality and morbidity. He is joined by Dr. Max Adelman, a practicing critical care and infectious disease physician at Houston Methodist Hospital. Dr. Adelman is an Assistant Professor of Medicine at Weill Cornell Medical College. Dr. Adelman’s clinical interests include bacteremia, hospital-acquired infections, immunocompromised hosts, multidrug-resistant organisms, and septic shock.

Additional Resources:

Invasive candidiasis in critically ill patients: Fundamental concepts and future directions. Perez MA, Hoffman WJ, Perez JC, and Adelman MH. CHEST 2026.

Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. JAMA 2016.

Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. THE LANCET- Infectious Diseases 2025.

Books and Music mentioned in this episode:

Four Thousand Weeks: Time Management for Mortals. By Oliver Bukerman.

Lonesome Drifter. By Charlie Crockett.

Surviving sepsis campaign 2026 guidelines Apr 23, 2026

Show notes

In this episode, Dr. Zanotti discusses the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. He is joined by Dr. Hallie Prescot and Dr. Bram Rochwerg. Dr. Hallie Prescott is an Associate Professor in Pulmonary & Critical Care Medicine at the University of Michigan and a staff physician at the Ann Arbor Veterans Affairs Healthcare System. She serves as co-chair of the international Surviving Sepsis Campaign Guidelines. Dr. Bram Rochwerg is an associate professor and critical care physician at McMaster University in Hamilton, Ontario, Canada. He is co-vice-chair of the Surviving Sepsis Campaign Adult Guidelines.

Additional Resources:

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026

Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026

SCCM Point-of-Care (POC) APP:

https://play.google.com/store/apps/details?id=org.sccm.mobl&hl=en

https://apps.apple.com/us/app/sccm-poc/id1079591546

Books and music mentioned in this episode:

William Osler: A Life in Medicine. By Michael Bliss

Blood Poison: The Untold Story of Sepsis. By Parsa Shahinpoor

Album: Bloodline Artist: Mon Rovia

Management of Impella Emergencies Apr 09, 2026

Show notes

In this episode, Dr. Sergio Zanotti discusses emergency management and resuscitation of patients with left-sided Impella support. We will base our discussion on a recently published United Kingdom multisociety consensus statement. Our guests for this episode are two of the authors of this consensus statement.

Dr. Zanotti is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trust in the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support. He is also joined by Dr. Vasileios Panoulas, a consultant cardiologist at Royal Brompton & Harefield NHS Trust and honorary senior clinical lecturer at Imperial College London. He has clinical expertise that encompasses both general and interventional cardiology.

Additional resources:

UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.nejm.org/doi/full/10.1056/NEJMoa2312572

Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.jacc.org/doi/abs/10.1016/j.jacc.2025.04.062

Long-Term Outcomes of the DanGer Shock Trial. DanGer Shock Investigators: https://pubmed.ncbi.nlm.nih.gov/40888722/

Music mentioned in this episode:

Unlearning. By Teddy Swims.

Minute a Moment. By Myles Smith.

Sable, Fable. By Bon Iver.

Acute Pulmonary Embolism: Clinical Guideline Update Mar 19, 2026

Show notes

In this episode Dr. Sergio Zanotti discusses the recently released Clinical Practice Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. This guideline is a report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. He is joined by Dr. Mark Creager, the lead author and chair of the writing committee for these guidelines. Dr. Creager is Professor of Medicine and Professor of Surgery at the Geisel School of Medicine at Dartmouth. A past president of the American Heart Association, he is an internationally recognized leader in vascular and cardiovascular medicine with more than 400 scientific publications. Additional resources: 2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2026: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415 Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2023: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST 20: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext Books mentioned in this episode: Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://bit.ly/4skCS0c Alexander Hamilton. By Ron Chernow: https://bit.ly/4rFuxTw Vascular Medicine: A Companion to Braunwald’s Heart Disease. By Mark Creager et al.: https://bit.ly/4uHZ4Dc

ECMO Emergencies Feb 12, 2026

Show notes

In this episode, Dr. Sergio Zanotti discusses a structured approach to ECMO emergencies, focusing on recognizing cardiac arrest, organizing the team response, and early ECMO troubleshooting to support key life-saving interventions. He is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trustin the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine, with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support Additional resources: British societies guideline on the management of emergencies in patients on extracorporeal membrane oxygenation. Waqas Akhtar, et al. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/41051555/ UK multisociety consensus statement on the emergency and resuscitation of patients with left-sided Impella support. Waqas Akhtar, et al. BMJ Journals 2026: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896 Books mentioned in this episode: His Dark Materials Series: The Golden Compass; The Subtle Knife; The Amber Spyglass: https://bit.ly/4cmSXgB

Acute Type B Aortic Dissection Dec 25, 2025

Show notes

In this episode of Critical Matters, Dr. Sergio Zanotti discusses the management of acute type B aortic dissection. He is joined by Dr. Firas Mussa, a vascular surgeon and professor at McGovern Medical School at UTHealth Houston. Dr. Mussa also holds a joint appointment with Imperial College in London. Additional resources: Management of Acute Type B Aortic Dissection. FF Mussa and P Kougias. N Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/40902163/ 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. EM Isselbacher, et al. Circulation 2022: https://pubmed.ncbi.nlm.nih.gov/36322642/ Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. JV Lombardi, et al. J Vasc Surg 2020: https://pubmed.ncbi.nlm.nih.gov/32001058/ Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. INSTEAD-XL Trial. CA Nienaber, et al. Circ Cardiovasc Inter 2013: https://pubmed.ncbi.nlm.nih.gov/23922146/ Books mentioned in this episode: A Dangerous Liaison: A Revelatory New Biography of Simon de Beauvoir and Jean-Paul Satre. By Carole Seymour-Jones: https://bit.ly/3L0pIov A Time For All Things: The Life of Michael E. DeBakey. By Craig Miller, et al.: https://bit.ly/44B2uMw

PCT Reassessed Dec 11, 2025

Show notes

In this episode, Dr. Zanotti discusses the role of Procalcitonin in the ICU. He is joined by Dr. Simran Gupta, an infectious disease specialist at Brigham & Women's Hospital in Boston. Dr. Gupta has additional training in Clinical Research, Transplant, and Infectious Disease. She recently published an article on reassessing the role of Procalcitonin in critically ill patients with sepsis. Additional resources: Reassessing Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients with Sepsis: Lessons from the ADAPT-Sepsis Trial. S. Gupta, et al. Clinical Infectious Disease 2025: https://pubmed.ncbi.nlm.nih.gov/40579227/ Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ Procalcitonin-guided antibiotic therapy may shorten the length of treatment and may improve survival- a systematic review and meta-analysis. M Papp, et al. Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37833778/ Books and entertainment mentioned in this episode: Shantaram: A Novel. By Gregory David Roberts: https://bit.ly/4ovVHKX SHANTARAM – Apple TV series: https://tv.apple.com/us/show/shantaram/umc.cmc.atxsrive40xli3zh3uxjimut

Capillary Refill Time (CRT) Nov 19, 2025

Show notes

In this episode, Dr. Sergio Zanotti discusses the assessment of peripheral perfusion as a tool to guide treatment in septic shock. Specifically, he dives into Capillary Refill Time. He is joined by Dr. Eduardo Kattan, a critical care and anesthesia physician. Dr. Kattan is an Assistant Professor at the Pontificia Catholic University of Chile, where he also serves as Adult Critical Care Program Director and Director of Research and Academics in the Department of Critical Care Medicine. A prolific investigator, he focuses his research on septic shock and medical education. Dr. Rattan is the Co-Principal Investigator of the recently published ANDROMEDA-SHOCK 2 clinical trial. Additional resources: Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock. The ANDORMEDA-SHOCK-2 Randomized Clinical Trial. JAMA 2025: https://jamanetwork.com/journals/jama/fullarticle/2840823 Effect of Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on. 28-Day Mortality Among Patients With Septic Shock. The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA 2019: https://jamanetwork.com/journals/jama/fullarticle/2724361 Perspectives on peripheral perfusion assessment. Eduardo Kattan, et al. Curr Opin Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37078639/ Books mentioned in this episode: The Little Prince. By Antoine de Saint-Exupery: https://bit.ly/49YcSRJ The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4i9PiUf

Peripheral vasopressors Oct 23, 2025

Show notes

In this episode, Dr. Sergio Zanotti discusses the administration of vasopressor agents through peripheral intravenous lines (or what we refer to as “peripheral vasopressors”). He is joined by Dr. Elizabeth Munroe, a practicing pulmonary/critical care physician and an Assistant Professor of Pulmonary and Critical Care at Intermountain Health in Salt Lake City, Utah. Her research interests include evidence-based resuscitation practices in early sepsis and septic shock, vasopressor administration practices, peripheral vasopressor use, and clinical trials, particularly novel, pragmatic clinical trial designs. Additional resources: Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension. ES Munroe, et al. JAMA Network 2025: https://pubmed.ncbi.nlm.nih.gov/40864467/ Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Shapiro NI, et al. CLOVERS Trial. New Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/36688507/ Overview of Peripheral Vasopressor Use in an Academic Health System. D Shyu, et al. Ann Am Thorac Soc 2025: https://pubmed.ncbi.nlm.nih.gov/40126143/ Safety of peripheral intravenous administration of vasoactive medication. J Cardenas-Garcia, et al. J Hosp Med 2015: https://pubmed.ncbi.nlm.nih.gov/26014852/ Books mentioned in this episode: Ending Medical Reversal- Improving Outcomes, Saving Lives. By Vinayak K. Parsad, et al: https://bit.ly/4nhCNam

Fluid Overload in the ICU Oct 09, 2025

Show notes

Fluid overload is a common problem in critically ill patients. In this episode, Dr. Sergio Zanotti discuss recognizing and managing fluid overload in the ICU with guest Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. Dr. Connor is a Professor and Senior Physician of Critical Care Medicine & Nephrology at the Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine at Emory University School of Medicine. Additionally, he serves as the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional resources European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3- fluid removal at de-escalation phase. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/40828463/ Optimizing Fluid Therapy in the Critically Ill. International Fluid Academy website – 2025: https://www.fluidacademy.org/2025/01/17/optimising-fluid-therapy-in-the-critically-ill-introduction-to-7d/ Fluid overload in the ICU: evaluation and management. R. Claure-Del Granado and R. L. Mehta. BMC Nephrology 2016: https://pubmed.ncbi.nlm.nih.gov/27484681/ Books and music mentioned in this episode: Think Again: The Power of Knowing What You Don’t Know. By Adam Grant: https://bit.ly/4gZvz9c RUSHMERE. By Mumford & Sons: https://bit.ly/473FzKc

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